4.0 The Birth Experience
The benchmark outcome of pregnancy is the normal vaginal birth of the baby, without any medical or pharmacological intervention and without complication for either mother or baby, followed by the baby being able to latch and breastfeed well. This may not be achievable for some women for whom the availability of skilled medical, nursing and pharmacological assistance is essential, but it is possible for the majority of women in the World.
Normal labor is a fragile entity. Once intervention occurs then a cascade of interventions inevitably follow.1Kroeger, 2004
Health care professionals have a responsibility to support and facilitate normal birthing. What happens to the mother during birthing has far-reaching effects on her relationship with her baby, her ability to breastfeed and the health of the mother and her child.

Poster available for purchase from NHS, UK
Lactation physiology
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() |
Lactogenesis is the making of breastmilk. There are three distinct phases.
| ![]() |
Lactogenesis II
Lactogenesis II will occur when:
- progesterone levels drop as a result of the removal of the placenta, AND
- prolactin levels are high as they are at the time of birthing, in the presence of
- normal insulin, thyroid hormones and glucocorticoids.
- Also, following birth, lactose secretion into colostrum increases, osmotically drawing water with it and increasing the volume of milk.
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]() Workbook Activity 4.1Complete Activity 4.1 in your workbook. | ![]() |
What could delay or inhibit lactogenesis II?
Hint: Remember it's an endocrine function, therefore consider hormonal causes.
Accidents at birthing may cause endocrine disruption. For example, retention of a functional portion of the placenta that continues to secrete progesterone, or a haemorrhage severe enough to cause Sheehan's syndrome (pituitary gland necrosis).
A delay in lactogenesis II occurs after assisted deliveries.2 Finding the cause of this delay and relating it to the physiology of lactogenesis has led researchers to look at the effect of stress.
Stress and breastfeeding
High stress levels are correlated with high cortisol levels. Cortisol, in normal concentrations, is also necessary to initiate lactogenesis II successfully, though what its role is isn't fully understood yet.
- Markers of both fetal and maternal stress during labor and delivery are associated with delayed breast fullness.3
- Maternal stress seems to interfere with the release of oxytocin causing poor milk removal, and a newborn who experienced stress during labor and delivery may be too weak or too sleepy to latch on and suckle effectively.4
- Onset of lactation occurred later in women who had higher cortisol levels. Primiparous women had higher levels than multiparous women. Stress during labor and/or delivery is likely to be a significant risk factor for delayed onset of lactation.5
What should I remember?
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() | ![]()
| ![]() |
Self-test quiz
![]() | ![]() | ![]() |
![]() | ![]() | ![]() |
![]() |
Match an item from the column on the left with an item from the column on the right. Click on an item in one column, then on its matching response from the other column | ![]() |
Notes
- # Kroeger M et al. (2004) Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum
- # Dewey KG et al. (2003) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss
- # Chen DC et al. (1998) Stress during labor and delivery and early lactation performance
- # Dewey KG (2001) Maternal and fetal stress are associated with impaired lactogenesis in humans
- # Grajeda R et al. (2002) Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women